Skip to main content

Vaginal Misoprostol for Cervical Ripening and Labour Induction in Late Pregnancy

Buy Article:

The full text article is temporarily unavailable.

We apologise for the inconvenience. Please try again later.

A substantive amendment to this systematic review was last made on 8 February 1999. Cochrane reviews are regularly checked and updated if necessary.

Background and objectives: Episiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear. The objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register.

Selection criteria: Randomised trials comparing restrictive use of episiotomy with routine use of episiotomy; restrictive use of mediolateral episiotomy versus routine mediolateral episiotomy; restrictive use of midline episiotomy versus routine midline episiotomy; and use of midline episiotomy versus mediolateral episiotomy.

Data collection and analysis: Trial quality was assessed and data were extracted independently by two reviewers.

Main results: Six studies were included. In the routine episiotomy group, 73.4% (1703/2319) of women had episiotomies, while the rate in the restrictive episiotomy group was 26.6% (619/2331). Compared with routine use, restrictive episiotomy involved less posterior perineal trauma (relative risk 0.88, 95% confidence interval 0.84–0.93), less suturing (relative risk 0.74, 95% confidence interval 0.71–0.77), and fewer healing complications (relative risk 0.69, 95% confidence interval 0.56–0.85). Restrictive episiotomy was associated with more anterior perineal trauma (relative risk 1.88, 95% confidence interval 1.62–2.18). There was no difference in severe vaginal or perineal trauma (relative risk 1.11, 95% confidence interval 0.83–1.50); dyspareunia (relative risk 1.02, 95% confidence interval 0.90–1.16); urinary incontinence (relative risk 0.98, 95% confidence interval 0.79–1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison.

Reviewers' conclusions: Restrictive episiotomy policies appear to have a number of benefits compared to routine episiotomy policies. There was less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures, and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy.

[This abstract has been prepared centrally.]

Citation: Carroli G, Belizan J, Stamp G. Episiotomy for vaginal birth (Cochrane Review). In: The Cochrane Library, Issue 2, 1999. Oxford: Update Software.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

Document Type: Miscellaneous

Publication date: 01 December 1999

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more